The Affordable Care Act (ACA), aka Obamacare, is law.  And its implementation is moving along slowly, but steadily. You have to give credit to the folks who believed in it, whether grass-roots supporters or highly placed politicians.  They rammed it down the American gullet like a lead ball down the muzzle of a Hawken rifle.  The problem is, once it goes off, the whole thing is going to explode. The reasons are ...

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She was 19 and hung herself from a tree in her backyard. You have the crumpled note that says goodbye. Her mother collapsed when you told her she had died. Her father wept into his hands. A chill crept up your spine. You hug your daughter extra close at home. Could that man be dying of cancer? He looks so young. His kids are so young, his wife so wounded ...

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I remember a time when many physicians, especially residents in various specialties, would moonlight in small emergency departments. They viewed it as a convenient way to supplement their low salaries. Some of them were excellent doctors. Sadly, quite a few were not qualified and caused more harm than good. I did the same thing, although I was a second- and third-year emergency medicine resident at the time. Indeed, the money came ...

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I’ve learned a few things about children over the years.  While most have come from raising children, the rest have come from caring for them as patients.  Knowing children, knowing their hearts and their ways, gives me great joy.  I like to think that as I know them better, I become more like them, and while my time on earth may not be any longer for it, it may be ...

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If I’m learning anything from working locum tenens jobs, it’s that there is a wide, mind-numbing variety of electronic medical records (EMR) systems in place around the country.  At my primary work site, we use Med-Host.  Like every EMR, it has some bugs. But having seen other systems in other places, it’s clearly a Cadillac product in a great, big car lot of Yugos. I’m not going to disparage other systems ...

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shutterstock_111707921 I just finished reading Neil Gaiman’s fascinating novel, Gods of America.  I first learned about his work by watching the movie Stardust, then reading the novel. One of the themes of Gods of America is that the deities of the old world came to America in the hearts of their followers, but over time lose their followers and thus their power.  A war is arranged between the ...

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Our nurses will soon have "scripting" guidelines for their interactions with patients.  This is apparently widespread in many industries.  The idea being, patients will be more satisfied with their care if certain key phrases are repeated to them; phrases which might, possibly, just maybe find their way onto satisfaction surveys.  Wink, wink! Whether I will have to engage in this tawdry bit of theater remains to be seen.  But bless the ...

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Dear hospitalists, This is just a note to say that we, in emergency medicine, appreciate you.  Like all of us, you are stuck in an endless loop of unending residency.  Don’t worry, it isn’t an episode of The Twilight Zone.  It’s just your life.  No, it’s our life! As specialty after specialty withdraws from the practice of medicine, you, and all of us, ...

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My patient was brought by EMS after a respiratory, and subsequent cardiac, arrest. She could not be intubated in the field, and I did so on her arrival. We actually restored some circulation, albeit not much. Over the course of an hour, despite our best efforts, she became blue again, with lividity pooling in her flanks. I ...

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"Hi, I’m Edwin, and I own firearms!" Right now, in the shadow of the horrors of the Sandy Hook shooting, it feels as if every gun-owner is on edge.  Some are apologizing, distancing themselves from gun advocacy groups.  Some are saying all the right words, "well, my target gun is locked in a safe."  Like telling your Baptist Preacher grandpa, "my whisky is in a cabinet and is only for medicinal ...

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Most modern American are familiar with the classic political novel, Atlas Shrugged.  Love or hate it, the novel had a great impact on political thinking in the West.  If you haven’t read it, or aren’t familiar, one of the fundamental questions author Ayn Rand asks is this:  what if the producers and innovators of society simply stopped trying?  What if they ...

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I recently treated two young men, both injured in the same football game.  On the way out, one passed the other in the hall, injuries treated and dressed. "See you next game!" they said.  They laughed and looked forward to the struggle. My wife and I have tried to raise our kids that way.  To enjoy life, to move through difficulty and injury. They suffer from having a physician father, so ...

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When I was a resident physician, I had the coolest classmates ever.  We worked together, laughed together, learned together and many of us stay in touch to this day.  Our practices have crossed the gamut of emergency medicine, with some in academics, some in private practice, some administrators, two involved in auto-racing medicine, one a bush-pilot/fishing guide and one an amateur mountaineer. But one of the things that united us, one ...

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Customer satisfaction is quite the rage these days. Many stores and restaurants, many professional offices, hand out surveys, or ask customers to log onto their survey site on the Internet. As a reward, one may win everything from a free sandwich to an iPad. I’d be interested to know how customer satisfaction played out in my home. "Kids, now you’ve had a week of school-work. Please fill out the attached survey ...

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I remember a short lecture I received in my medical officer's course when I joined the Air National Guard around 1988. The room was full of young medical students, physicians, nurses, and other health care folks who were beginning their service. The topic was appropriate documentation in the medical record. Among the notable examples of what not to do was this gem, written by a medical officer about another officer's wife: ...

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For 19 years since residency, I have worked in one facility and one facility only.  I have paced its halls and touched its walls, known every crack and heard every sound.  I have seen life and death, laughed and cried there.  And yet, I began to have a wandering eye… Actually, I needed a little more immediate cash.  I began to flirt with ... locums! So, after some phone calls, some furtive, ...

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Our septic tank backed up recently. When I say backed up, I mean, into the basement. And when I say into the basement, I mean, out of the bathroom and onto the carpet. And under the walls. The stars were aligned, and I had to go to work. My wife borrowed a Shop-Vac and rented a steam cleaner. I was assigned to call the septic-tank guy. The kids helped clean ...

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shutterstock_222923164 I was talking to some new friends over lunch recently, at the nationally renowned Hominy Cafe, in Charleston, SC. Any place with a fried green tomato BLT, and shrimp and grits for breakfast, has my vote! To the point: my question to these esteemed emergency medicine educators was this: "Do you ever have irrational fears about the people you love, because of ...

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Some things in medicine are obvious.  Despite the endless worship of ‘evidence-based’ medicine, and the constant barrage of studies on every conceivable topic, we do certain things because we know they just seem right.  I take as evidence the fact that we daily try to save lives, devoting research time, untold gazillions of  dollars and heroic clinical effort to our continued goal of staving off death.  Why is this?  Do ...

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shutterstock_155347391 March 29, 2012 Calhoun Lecture Series Strom Thurmond Institute, Clemson University Thank you for the invitation to speak tonight. I’m very humbled to stand before you. And what a delight to speak to people who are neither bleeding, intoxicated nor asking for Percocet! And in a setting where no one will burst through the back door on a stretcher! As you know, I’m an emergency physician ...

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